Best practice assessment and management of benign paroxysmal positional vertigo in older adults

Abstract

Benign paroxysmal positional vertigo (BPPV) is a common and disabling condition, with prevalence increasing with advancing age. It typically causes positional dizziness but is also common in those with balance abnormalities and falls without the typical dizziness. It is an underdiagnosed problem, which can lead to reduced quality of life, depression and increased falls risk. Whilst the diagnosis and treatment of the commonest form of BPPV (posterior canal) is straightforward in robust and younger populations, this is frequently not the case in people with multiple long-term conditions or frailty. Barriers to diagnosis and treatment of BPPV in each of the three canals can be overcome with simple practical measures, which are presented here. Given the lack of good quality evidence in this area, this best practise article presents evidence, where it exists, alongside expert clinical experience.

Keywords: benign paroxysmal positional vertigo; older adult; postural balance; vertigo.

Figure 1

Modified Dix–Hallpike over pillow using wider examination couch (see Video 1 in the online material).

Figure 2

Side lying test.

Figure 3

Dix–Hallpike test with head down tilt of 30° (see online Video 2).

Figure 4

Supine roll test using log roll technique maintaining cervical neutral position (see online Video 3).

Figure 5

Side lying test with head of bed angled 20° down (see online Video 4).